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1.
J Telemed Telecare ; 28(9): 687-693, 2022 Oct.
Article in English | MEDLINE | ID: mdl-32990153

ABSTRACT

INTRODUCTION: The prevalence of diabetes is increasing around the world, especially in populations with limited health service resources. Diabetes is associated with increased mortality and cost. Therefore, we investigated the impact of increasing access to diabetes care through telemedicine. METHODS: Five rural communities were connected via videoconference. Patients received diabetes consultation (DC) or diabetes self-management education (DSME). DC was performed by an endocrinologist, while DSME was delivered by a certified diabetes educator. Haemoglobin A1c (HbA1c), blood pressure (BP) and lipid profile were evaluated as outcome measures. RESULTS: Sixty-nine subjects (70% females, 91% Caucasians) were studied, with 33 receiving DC and 36 receiving DSME. Patients were aged 56.7 ± 9.4 and 56.5 ± 6.7 years, respectively (p > 0.5), and had had diabetes for 11.4 ± 10.1 and 11.7 ± 9.2 years, respectively (p > 0.5). Both DC and DSME reduced HbA1c equally: DC at baseline 9.3 ± 1.3% compared to at 12 months 7.2 ± 0.9% (p = 0.0002), and DSME at baseline 9.8 ± 1.6% compared to at 12 months 8.3 ± 1.9% (p = 0.009). There was no difference in HbA1c between DC and DSME at baseline and at 12 months (p > 0.1). On the average, BP and lipids were equally controlled in DC and DSME at six months: total cholesterol 178.3 ± 50.5 mg/dL versus 185.9 ± 57.3 mg/dL, low-density lipoprotein cholesterol 91.4 ± 36.1 mg/dL versus 91.5 ± 50.2 mg/dL, high-density lipoprotein cholesterol 46.2 ± 11.0 mg/dL versus 43.5 ± 10.8 mg/dL, systolic BP 136.8 ± 23.6 mmHg versus 131.9 ± 22.3 mmHg, diastolic BP 72.0 ± 13.2 mmHg versus 77.7 ± 11.3 mmHg (p > 0.1). All subjects found DC and DSME cost effective, while 97% reported better diabetes control. DISCUSSION: In patients with long-standing uncontrolled diabetes who lived in rural communities with high diabetes-related mortality rates, DC or DSME delivered by videoconference improved glycemic control. No difference was found between the two interventions.


Subject(s)
Diabetes Mellitus, Type 2 , Telemedicine , Aged , Blood Glucose , Cholesterol , Female , Glycated Hemoglobin/analysis , Humans , Male , Middle Aged , Referral and Consultation
2.
Am J Med Sci ; 356(2): 181-184, 2018 08.
Article in English | MEDLINE | ID: mdl-30219161

ABSTRACT

Nonislet cell tumor hypoglycemia is rare. We highlight the diagnosis and treatment of recurrent severe hypoglycemia in a 49-year-old woman with malignant solitary fibrous tumor of the pleura (Doege-Potter syndrome). The clinical, laboratory and radiologic findings of the case are presented and a brief literature review is provided. Of note, imaging studies showed a large mass in the right hemithorax and pathology and immunehistochemical stains confirmed a malignant solitary fibrous tumor of the pleura. She was a poor surgical candidate owing to a large tumor burden. She was treated with a combination of temozolomide and bevacizumab to which she responded with resolution of hypoglycemia. The treatment of choice for hypoglycemia in patients with the Doege-Potter syndrome is surgical excision. We here report that a combination of temozolomide and bevacizumab may be a viable option in patients with inoperable disease.


Subject(s)
Bevacizumab/adverse effects , Fibroma , Hypoglycemia/chemically induced , Pleural Neoplasms , Temozolomide/adverse effects , Bevacizumab/administration & dosage , Female , Fibroma/diagnosis , Fibroma/drug therapy , Humans , Middle Aged , Pleural Neoplasms/diagnosis , Pleural Neoplasms/drug therapy , Temozolomide/administration & dosage
3.
BMJ Open Diabetes Res Care ; 6(1): e000511, 2018.
Article in English | MEDLINE | ID: mdl-29892337

ABSTRACT

OBJECTIVE: Resting energy expenditure (REE) is linked to obesity, insulin resistance and type 2 diabetes (T2DM). REE and T2DM are inherited traits. Therefore, we investigated the effect of parental T2DM on REE in normoglycemic subjects. METHODS: Eighty-seven subjects with parental T2DM and 83 subjects without parental T2DM were matched in age, gender, race, BMI, weight and waist circumference. Subjects underwent a 75 g oral glucose tolerance test; REE was determined by indirect calorimetry and body composition was assessed by dual energy X-ray absorptiometry. Statistical analysis was performed using Student's t-test, analysis of variance and regression analysis. RESULTS: The mean age was 38.8±11.3 years, 57% were females and 53% were African-Americans. The mean BMI was 28.5±6.1 kg/m2, waist circumference 91.8±15.1 cm, weight 83.9±20.3 kg, fat mass 31.0%±10.0%, mean fat-free mass (FFM) 54.4±12.9 kg. REE was significantly lower in subjects with parental diabetes, normalized REE 1364.4±263.4Kcal/day vs 1489.4±323.2 Kcal/day, p=0.006 and 29.2±5.3Kcal/kg FFM/day vs 31.9±6.0 Kcal/kg FFM/day, p=0.002. African-Americans had a lower REE compared with Caucasians 28.6±5.4Kcal/kg FFM/day vs 32.6±5.5 Kcal/kg FFM/day, p<0.0001. In a multiple regression model, ethnicity (p<0.0001), parental history of T2DM (p=0.006) and FFM (p=0.021) were independent predictors of REE. CONCLUSION: Compared with subjects without parental diabetes, offspring with parental T2DM had lower REE, which was more pronounced in African-Americans. This metabolic alteration could increase the risk of obesity, insulin resistance and dysglycemia.

4.
Metabolism ; 65(4): 507-21, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26975543

ABSTRACT

The prognosis of diabetic ketoacidosis has undergone incredibly remarkable evolution since the discovery of insulin nearly a century ago. The incidence and economic burden of diabetic ketoacidosis have continued to rise but its mortality has decreased to less than 1% in good centers. Improved outcome is attributable to a better understanding of the pathophysiology of the disease and widespread application of treatment guidelines. In this review, we present the changes that have occurred over the years, highlighting the evidence behind the recommendations that have improved outcome. We begin with a discussion of the precipitants and pathogenesis of DKA as a prelude to understanding the rationale for the recommendations. A brief review of ketosis-prone type 2 diabetes, an update relating to the diagnosis of DKA and a future perspective are also provided.


Subject(s)
Diabetic Ketoacidosis/pathology , Diabetic Ketoacidosis/therapy , Animals , Diabetes Mellitus/therapy , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/etiology , Humans , Incidence
5.
Endocr Pract ; 20(3): 201-6, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24014006

ABSTRACT

OBJECTIVE: The initial assessment of metabolic acidosis in subjects with diabetic ketoacidosis (DKA) is arterial blood gas analysis. This process is expensive, painful, and technically difficult. Furthermore, blood gas analysis may not be available in some facilities, especially in developing countries where DKA-associated morbidity and mortality remain high. Therefore, we investigated the utility of venous bicarbonate concentration obtained from a basic metabolic panel in predicting arterial pH in adults with DKA. METHODS: We performed a retrospective analysis of clinical and biochemical data of 396 adults admitted to 2 community teaching hospitals with DKA. We determined the correlation between arterial pH and venous serum parameters. Using multiple logistic regression, we obtained a predictive formula for arterial pH from serum venous bicarbonate level. RESULTS: The patient population was 59.0% male and had a mean age of 36.7 ± 13.3 years. We derived that arterial pH = 6.97 + (0.0163 x bicarbonate), and by applying this equation, we determined that serum venous bicarbonate concentration of ≤20.6 mEq/L predicted arterial pH ≤7.3 with over 95% sensitivity and 92% accuracy. CONCLUSION: Venous serum bicarbonate obtained from the basic metabolic panel is an affordable and reliable way of estimating arterial pH in adults with DKA. Validation of this formula in a prospective study would offer a more accessible means of estimating metabolic acidosis in adults with DKA, especially in developing countries where DKA incidence and mortality remain high.


Subject(s)
Bicarbonates/blood , Diabetic Ketoacidosis/metabolism , Adult , Female , Humans , Hydrogen-Ion Concentration , Logistic Models , Male , Middle Aged , Retrospective Studies , Veins
6.
Diabetes Care ; 36(7): 1919-25, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23404297

ABSTRACT

OBJECTIVE: To study the effects of high-protein versus high-carbohydrate diets on various metabolic end points (glucoregulation, oxidative stress [dichlorofluorescein], lipid peroxidation [malondialdehyde], proinflammatory cytokines [tumor necrosis factor-α and interleukin-6], adipokines, and resting energy expenditure [REE]) with high protein-low carbohydrate (HP) and high carbohydrate-low protein (HC) diets at baseline and after 6 months of dietary intervention. RESEARCH DESIGN AND METHODS: We recruited obese, premenopausal women aged 20-50 years with no diabetes or prediabetes who were randomized to HC (55% carbohydrates, 30% fat, and 15% protein) or HP (40% carbohydrates, 30% fat, and 30% protein) diets for 6 months. The diets were provided in prepackaged food, which provided 500 kcal restrictions per day. The above metabolic end points were measured with HP and HC diet at baseline and after 6 months of dietary intervention. RESULTS: After 6 months of the HP versus HC diet (12 in each group), the following changes were significantly different by Wilcoxon rank sum test for the following parameters: dichlorofluorescein (-0.8 vs. -0.3 µmol/L, P < 0.0001), malondialdehyde (-0.4 vs. -0.2 µmol/L, P = 0.0004), C-reactive protein (-2.1 vs. -0.8 mg/L, P = 0.0003), E-selectin (-8.6 vs. -3.7 ng/mL, P = 0.0007), adiponectin (1,284 vs. 504 ng/mL, P = 0.0011), tumor necrosis factor-α (-1.8 vs. -0.9 pg/mL, P < 0.0001), IL-6 (-1.3 vs. -0.4 pg/mL, P < 0.0001), free fatty acid (-0.12 vs. 0.16 mmol/L, P = 0.0002), REE (259 vs. 26 kcal, P < 0.0001), insulin sensitivity (4 vs. 0.9, P < 0.0001), and ß-cell function (7.4 vs. 2.1, P < 0.0001). CONCLUSIONS: To our knowledge, this is the first report on the significant advantages of a 6-month hypocaloric HP diet versus hypocaloric HC diet on markers of ß-cell function, oxidative stress, lipid peroxidation, proinflammatory cytokines, and adipokines in normal, obese females without diabetes.


Subject(s)
Adipokines/metabolism , Cytokines/metabolism , Dietary Carbohydrates , Dietary Proteins , Insulin-Secreting Cells/metabolism , Lipid Peroxidation/physiology , Obesity/metabolism , Oxidative Stress/physiology , Adult , Female , Humans , Middle Aged , Premenopause , Risk Factors , Weight Loss , Young Adult
7.
Diabetes Res Clin Pract ; 94(3): 340-51, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21978840

ABSTRACT

The hyperglycemic emergencies, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are potentially fatal complications of uncontrolled diabetes mellitus. The incidence of DKA and the economic burden of its treatment continue to rise, but its associated mortality rate which was uniformly high has diminished remarkably over the years. This Improvement in outcome is largely due to better understanding of the pathogenesis of hyperglycemic emergencies and the application of evidence-based guidelines in the treatment of patients. In this article, we present a critical review of the evidence behind the recommendations that have resulted in the improved prognosis of patients with hyperglycemic crises. A succinct discussion of the pathophysiology and important etiological factors in DKA and HHS are provided as a prerequisite for understanding the rationale for the effective therapeutic maneuvers employed in these acute severe metabolic conditions. The evidence for the role of preventive measures in DKA and HHS is also discussed. The unanswered questions and future research needs are also highlighted.


Subject(s)
Diabetes Complications/drug therapy , Diabetes Mellitus/physiopathology , Diabetic Ketoacidosis/drug therapy , Hyperglycemic Hyperosmolar Nonketotic Coma/drug therapy , Diabetes Complications/etiology , Diabetic Ketoacidosis/etiology , Evidence-Based Medicine , Humans , Hyperglycemic Hyperosmolar Nonketotic Coma/etiology
9.
Metabolism ; 60(1): 1-23, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21134520

ABSTRACT

The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes. Although the pathogenesis and long-term complications of type 2 diabetes are fairly well known, its treatment has remained challenging, with only half of the patients achieving the recommended hemoglobin A(1c) target. This narrative review explores the pathogenetic rationale for the treatment of type 2 diabetes, with the view of fostering better understanding of the evolving treatment modalities. The diagnostic criteria including the role of hemoglobin A(1c) in the diagnosis of diabetes are discussed. Due attention is given to the different therapeutic maneuvers and their utility in the management of the diabetic patient. The evidence supporting the role of exercise, medical nutrition therapy, glucose monitoring, and antiobesity measures including pharmacotherapy and bariatric surgery is discussed. The controversial subject of optimum glycemic control in hospitalized and ambulatory patients is discussed in detail. An update of the available pharmacologic options for the management of type 2 diabetes is provided with particular emphasis on newer and emerging modalities. Special attention has been given to the initiation of insulin therapy in patients with type 2 diabetes, with explanation of the pathophysiologic basis for insulin therapy in the ambulatory diabetic patient. A review of the evidence supporting the efficacy of the different preventive measures is also provided.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Blood Glucose/analysis , Cardiovascular Diseases/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/etiology , Exercise , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents/therapeutic use , Intensive Care Units , Metformin/therapeutic use
10.
Diabetes Care ; 33(8): 1837-9, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20484127

ABSTRACT

OBJECTIVE: The etiology of altered sensorium in diabetic ketoacidosis (DKA) remains unclear. Therefore, we sought to determine the origin of depressed consciousness in DKA. RESEARCH DESIGN AND METHODS: We analyzed retrospectively clinical and biochemical data of DKA patients admitted in a community teaching hospital. RESULTS: We recorded 216 cases, 21% of which occurred in subjects with type 2 diabetes. Mean serum osmolality and pH were 304 +/- 31.6 mOsm/kg and 7.14 +/- 0.15, respectively. Acidosis emerged as the prime determinant of altered sensorium, but hyperosmolarity played a synergistic role in patients with severe acidosis to precipitate depressed sensorium (odds ratio 2.87). Combination of severe acidosis and hyperosmolarity predicted altered consciousness with 61% sensitivity and 87% specificity. Mortality occurred in 0.9% of the cases. CONCLUSIONS: Acidosis was independently associated with altered sensorium, but hyperosmolarity and serum "ketone" levels were not. Combination of hyperosmolarity and acidosis predicted altered sensorium with good sensitivity and specificity.


Subject(s)
Acidosis/physiopathology , Diabetic Ketoacidosis/physiopathology , Acidosis/metabolism , Adult , Diabetic Ketoacidosis/metabolism , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
11.
Am J Med Sci ; 338(3): 190-5, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19745609

ABSTRACT

BACKGROUND: Increased incidence of cardiovascular mortality and nonalcoholic fatty liver disease (NAFLD) has been reported in hypopituitarism, but previous studies did not correct for obesity in these patients. Therefore, it remained unclear if endocrine deficiency in hypopituitarism is associated with metabolic consequences independent of obesity. This study was designed to determine the burden of cardiovascular disease and NAFLD in hypopituitarism. METHODS: We performed a retrospective case-control analysis of hypopituitary patients at Veterans Affair Medical center, Memphis, from January 1997 to June 2007. After matching for age, gender, obesity, and race, relevant data were abstracted from the subjects' records to determine the presence of hypopituitarism, cardiovascular risk factors, and fatty liver disease. Cases and controls were characterized by descriptive statistics and compared using chi(2) and Student t tests. RESULTS: Hypopituitary patients exhibited higher prevalence of hypertension- 88% versus 78% (P < 0.03), hypertriglyceridemia-80% versus 70% (P = 0.05), low high-density lipoprotein cholesterol-84% versus 70% (P < 0.001), and metabolic syndrome-90% versus 71% (P < 0.001). Patients also had higher mean plasma glucose levels-228 +/- 152 versus 181 +/- 83 mg/dL (P < 0.01). Despite higher preponderance of cardiovascular risk factors in hypopituitary patients, prevalence of cardiovascular morbidity was similar in both groups (P > 0.3). Hypopituitary patients had higher elevations in serum aminotransferase levels and hyperbilirubinemia-24% versus 11% (P < 0.01), as well as higher international normalized ratio (INR) and hypoalbuminemia 40% versus 23% (P < 0.01). CONCLUSIONS: There is an increased prevalence of metabolic syndrome and liver dysfunction consistent with NAFLD in hypopituitarism. Although hypopituitary patients had higher prevalence of cardiovascular risk factors than controls, they were not disproportionately affected by cardiovascular disease.


Subject(s)
Fatty Liver/epidemiology , Hypopituitarism/complications , Metabolic Syndrome/epidemiology , Aged , Cohort Studies , Fatty Liver/etiology , Female , Humans , Male , Metabolic Syndrome/etiology , Middle Aged , Prevalence , Tennessee/epidemiology
12.
Am J Med Sci ; 337(1): 37-40, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19155752

ABSTRACT

BACKGROUND: Iodine deficiency disorders (IDD) constitute significant public health problems in parts of the world with poor iodine nutrition, but have been eradicated in North America and other regions. We herein report 3 cases of IDD, which occurred in women living in iodine-replete environments. METHODS: The clinical presentation, biochemical findings, and radiological features of the patients were analyzed and presented in 3 case reports. The radiological features are illustrated in sonographic and scintigraphic images. A literature review and discussion, which highlight the risk factors, pathogenesis, ancillary investigations, and rational treatment of iodine deficiency goiter and hypothyroidism are provided. RESULTS: All 3 patients were young women, aged 24 to 38 years, who had goiter. Two of them presented with goitrous hypothyroidism. Radioactive iodine scintigraphy showed a characteristic finding of diffusely increased uptake (in the absence of clinical and biochemical evidence of hyperthyroidism). This scintigraphic pattern was found to be pathognomonic. Dietary iodine supplementation alone resulted in complete remission of IDD in the subjects, including the 2 patients with hypothyroidism. CONCLUSION: IDD can occur in iodine-replete environments. A high index of suspicion is needed to recognize these cases. It is pertinent that the correct diagnosis be made to avoid unwarranted life-long thyroxine therapy in patients presenting with goiter and hypothyroidism, which is easily treatable with iodized salt. These cases underscore the need for considering iodine deficiency in the etiologic diagnosis of goiter and hypothyroidism, even in iodine-sufficient regions.


Subject(s)
Iodine/deficiency , Adult , Female , Humans , Iodine/administration & dosage , Thyrotropin/blood
13.
Am J Med Sci ; 336(6): 524-6, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19092330

ABSTRACT

Glycohemoglobin (HbA1c) estimation is the gold standard for assessing long-term glycemic control in diabetic patients. Some hemoglobin variants interfere with HbA1c assay, thus, limiting its utility. Over 150,000 diabetic patients are estimated to have hemoglobin variants in the United States; but this number may be up to 30% in some parts of the world. Although, most of the hemoglobinopathies are clinically silent, some of them cause biochemical aberrations, which could interfere with HbA1c assay. However, hemoglobin N-Baltimore has not been reported to give false HbA1c estimation. We present a woman with mistaken diagnosis of diabetes due to hemoglobin N-Baltimore that produced a spuriously elevated HbA1c level.


Subject(s)
Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Hemoglobins, Abnormal/metabolism , Adult , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/physiopathology , Female , Glycated Hemoglobin/metabolism , Humans
14.
J Radiol Case Rep ; 2(4): 1-4, 2008.
Article in English | MEDLINE | ID: mdl-22470595

ABSTRACT

Lithium carbonate, a widely used treatment for bipolar disorders, is associated with goiter, hypothyroidism and thyrotoxicosis. However, the effect of lithium to increase radioactive iodine uptake has received little attention, thus, making Lithium a confounding factor in the interpretation of thyroid radionuclide studies. We herein report a case of misinterpreted high radioactive iodine uptake in a euthyroid, lithium-treated goitrous patient. We conclude that lithium therapy should be considered in the etiologic diagnoses of patients with goiter and homogenously elevated radioiodine uptake. It is pertinent to recognize this phenomenon in order to prevent unwarranted treatment with radioactive iodine or thionamides.

16.
Endocr Pract ; 13(1): 22-9, 2007.
Article in English | MEDLINE | ID: mdl-17360297

ABSTRACT

OBJECTIVE: To identify the risk factors for recurrent diabetic ketoacidosis (DKA) in a city hospital. METHODS: We performed a retrospective analysis of sequential adult admissions for DKA at Bronx Lebanon Hospital Center in New York between July 1, 2001, and June 30, 2004. The patients were divided into cohorts, which were compared with use of analysis of variance and X2 tests. Multivariate logistic regression analysis was performed where indicated. RESULTS: In 168 patients (96 men and 72 women), 219 episodes of DKA occurred. The mean age (+/- SD) of the overall study group was 38.6 +/- 14.8 years. Fifty-four patients (32%) had type 2 diabetes, and 44 patients (26%) had new-onset diabetes. The recurrence rate of DKA was 169% in cocaine users and 39% in nonusers (P<0.0001). Active use of cocaine, noncompliance, and Hispanic ethnicity emerged as independent risk factors for recurrent DKA-odds ratio (OR) = 4.38, P = 0.001; OR = 1.96, P = 0.05; and OR = 0.40, P = 0.005, respectively. The commonest precipitants of DKA were noncompliance (44%) and infection (26%). Noncompliance was associated with use of cocaine, use of cannabis, and cigarette smoking (P = 0.008, 0.04, and 0.01, respectively). In 91 of the hospital admissions for DKA (42%), the patients were active smokers. CONCLUSION: Active use of cocaine is an independent risk factor for recurrent DKA, as are noncompliance and Hispanic ethnicity. Of these 3 factors, cocaine showed the strongest association with DKA. Therefore, toxicology screening in patients with recurrent DKA may be prudent and worthwhile.


Subject(s)
Cocaine-Related Disorders/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/epidemiology , Adult , Black or African American/statistics & numerical data , Aged , Aged, 80 and over , Female , Glycated Hemoglobin/metabolism , Hispanic or Latino/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Logistic Models , Male , Middle Aged , Outpatients/statistics & numerical data , Patient Compliance , Recurrence , Retrospective Studies , Risk Factors , White People/statistics & numerical data
17.
Endocrinol Metab Clin North Am ; 35(4): 725-51, viii, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17127143

ABSTRACT

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) potentially are fatal but largely preventable acute metabolic conditions of uncontrolled diabetes, the incidence of which continues to increase. Mortality from DKA has declined remarkably over the years because of better understanding of its pathophysiology and treatment. The mortality rate of HHS remains alarmingly high, however, owing to older age and mode of presentation of patients and associated comorbid conditions. DKA and HHS also are economically burdensome; therefore, any resources invested in their prevention would be rewarding.


Subject(s)
Diabetic Ketoacidosis , Hyperglycemic Hyperosmolar Nonketotic Coma , Bicarbonates/therapeutic use , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/prevention & control , Diabetic Ketoacidosis/therapy , Fluid Therapy , Humans , Hyperglycemic Hyperosmolar Nonketotic Coma/diagnosis , Hyperglycemic Hyperosmolar Nonketotic Coma/prevention & control , Hyperglycemic Hyperosmolar Nonketotic Coma/therapy , Insulin/administration & dosage , Patient Education as Topic , Phosphates/therapeutic use , Potassium/therapeutic use , Potassium Compounds/therapeutic use
18.
Diabetes Res Clin Pract ; 62(3): 177-85, 2003 Dec.
Article in English | MEDLINE | ID: mdl-14625132

ABSTRACT

OBJECTIVES: This study aimed to assess the prevalence rates of type 2 diabetes and to determine potential associated risk factors of the disease in Port Harcourt, Nigeria. RESEARCH DESIGN AND METHODS: Five hundred and two (502) subjects aged above 40 years, obtained by a two-stage cluster sampling technique participated in this survey. Casual (random) plasma glucose estimations were done for all subjects after relevant personal data were obtained. Subjects with casual plasma glucose (CPG) > or =7.0 mmol/l had oral glucose tolerance tests (OGTT) done. Fasting and 2 h post glucose load blood samples were analyzed for plasma glucose levels. RESULTS: Thirty-four (34) subjects had diabetes, giving a crude prevalence rate of 6.8% (CI=4.6-9.0%), and standardized rate of 7.9%. The crude prevalence rates were 7.7 and 5.7% for males and females, respectively. Of the 34 diabetic subjects seen, 14 (41.2%) of them were not previously known to have diabetes; 83.7% of these were asymptomatic. Body mass index (BMI) > or = 25 kg/m2 and WHR > or = 0.85, family history of diabetes, physical inactivity, heavy consumption of alcohol, older age as well as high social status and Hausa-Fulani or Ibibio origin were associated with significantly higher prevalence of type 2 diabetes. CONCLUSION: The prevalence of type 2 diabetes in Port Harcourt is relatively high. Changing lifestyle associated with industrialization may explain this. A significant proportion of the diabetic subjects are asymptomatic and undiagnosed. The risk factors as shown in our study clearly emphasize the point that type 2 diabetes is to a large extent a preventable disease.


Subject(s)
Diabetes Mellitus, Type 2/epidemiology , Adult , Body Constitution , Body Mass Index , Ethnicity , Geography , Humans , Incidence , Middle Aged , Nigeria/epidemiology , Patient Selection , Prevalence , Risk Factors , Sex Characteristics , Software
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